Remarkable response to roxadustat in a case of anti-erythropoietin antibody-mediated pure red cell aplasia

Wan, Ke; Yin, Yuqin; Luo, Zimian; Cheng, Jun

doi:10.1007/s00277-020-04269-y

Cited by 9 publications

(16 citation statements)

References 5 publications

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“…For one case, 3.5 months after starting roxadustat treatment, the patient's hemoglobin and reticulocyte count rose dramatically accompanied by high level of serum EPO. Bone marrow aspiration smear demonstrated a return to normal in erythroid cells 7 . For another case, although anti‐EPO antibody turned negative after immunosuppressive therapy for 3 months, the patient's hemoglobin still could not be maintained.…”

Section: Discussionmentioning

confidence: 96%

“…Bone marrow aspiration smear demonstrated a return to normal in erythroid cells. 7 For another case, although anti-EPO antibody turned negative after immunosuppressive therapy for 3 months, the patient's hemoglobin still could not be maintained. Therefore, roxadustat was administered to treat anemia.…”

Section: Discussion and Con Clus I On Smentioning

confidence: 99%

“…Another hypothesis is that endogenous EPO induced by roxadustat contributed to neutralizing anti-EPO antibodies but not boost production of new antibodies to EPO. 7 However, this assumption still lacks strong evidences.…”

Section: Discussion and Con Clus I On Smentioning

confidence: 99%

“…However, the role of HIF on immune regulation is still controversial, and more experiments are needed to evaluate the effect of long‐term use of roxadustat on antibody response. Another hypothesis is that endogenous EPO induced by roxadustat contributed to neutralizing anti‐EPO antibodies but not boost production of new antibodies to EPO 7 . However, this assumption still lacks strong evidences.…”

Section: Discussionmentioning

confidence: 99%

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Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Peng

2021

Seminars in Dialysis

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Anti-erythropoietin antibody-related pure red cell aplasia (anti-EPO PRCA) is a severe complication in patients who receive erythropoiesis-stimulating agents for nephrogenic anemia. The standard therapy is withdrawl of EPO and immunosuppression.Here, we present successful treatment of anti-EPO PRCA with roxadustat, a hypoxiainducible factor prolyl hydroxylase inhibitor. A 39-year-old woman with end-stage renal disease received recombinant human erythropoietin (rhEPO) subcutaneously.Unfortunately, she developed anti-EPO PRCA and her hemoglobin dropped continuously, whereas she rejected immunosuppressive therapy. The patient failed to achieve How to cite this article: Wu R, Peng Y. Roxadustat on anti-erythropoietin antibody-related pure red cell aplasia in the patient with end-stage renal disease. Semin Dial.

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Section: Discussionmentioning

confidence: 96%

Section: Discussion and Con Clus I On Smentioning

confidence: 99%

Section: Discussion and Con Clus I On Smentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Peng

2021

Seminars in Dialysis

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“…In one case, roxadustat was administered as re-treatment for renal anemia after immunosuppressive therapy (20). In another case, roxadustat was administered instead of immunosuppressive (21). HIF-PHIs may thus be a safe option for treating renal anemia in patients with antibody-mediated PRCA.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Antibody-mediated Pure Red Cell Aplasia Induced by Continuous Erythropoietin Receptor Activator with Prednisolone

et al. 2022

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Pure red cell aplasia (PRCA) associated with erythropoiesis-stimulating agents (ESAs), which were first reported in 1998, usually occurs with subcutaneous administration of epoetin alfa (Eprex Ⓡ ). Improvements in ESA storage, handling, and administration methods have reduced the PRCA incidence. Continuous erythropoietin receptor activator (CERA) is a third-generation ESA that is rarely reported to induce PRCA. We herein report a case of CERA-induced PRCA presenting with positive anti-erythropoietin (EPO) and anti-CERA antibodies, which was successfully treated with prednisolone. Clinicians should be aware of the possibility of antibody-mediated PRCA induced by an ESA in CKD patients with anemia with reticulocytopenia and low serum EPO levels.

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Positive response of a hemodialysis patient with pure red cell aplasia on recombinant human erythropoietin therapy to cyclosporine and Roxadustat

Ma,

Pai,

Zhu

et al. 2024

CEN Case Rep

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Recombinant human erythropoietin (rHuEPO) is commonly used to treat anemia associated with chronic kidney disease (CKD). EPO-induced Pure Red Cell Aplasia (PRCA) is a rare condition of profound anemia with EPO treatment. Upon finding the development of EPO-induced PRCA, the treatment requires immediate withdrawal of EPO therapy and initiate new treatments with immunosuppression or renal transplantation. Anti-EPO antibody assay is not always positive in EPO-induced PRCA. Here, we report a case on the sudden development of PRCA in a hemodialysis patient receiving EPO and how we treated the condition successfully with cyclosporine and subsequently maintained the hemoglobin with Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI). Even though the anti-EPO antibody was negative by Enzyme Linked Immunosorbent Assay (ELISA) in our case, the clinical course, the markedly reduced reticulocyte count < 10,000/μL, the bone marrow (BM) biopsy revealing reduced erythroblasts, and its subsequent response to cyclosporine, were similar to EPO-induced PRCA. The clinical picture of EPO-induced PRCA, the limitation of the EPO-neutralizing antibody (Ab) assay, and treatment strategies were discussed.

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Remarkable response to roxadustat in a case of anti-erythropoietin antibody-mediated pure red cell aplasia

Cited by 9 publications

References 5 publications

Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Successful Treatment of Antibody-mediated Pure Red Cell Aplasia Induced by Continuous Erythropoietin Receptor Activator with Prednisolone

Positive response of a hemodialysis patient with pure red cell aplasia on recombinant human erythropoietin therapy to cyclosporine and Roxadustat

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